Learning on the Destitute: Student-Run Free Clinics and the Option for the Poor
Hannah Hittson, UT Southwestern Medical School, Dallas, TX and Kayal Parthiban, UMass Chan Medical School, Worcester, MA
Anthropologist and physician Paul Farmer writes in Pathologies of Power, “To those concerned, with health, a preferential option for the poor offers both a challenge and an insight. It challenges doctors and other health providers to make an option—a choice—for the poor, to work on their behalf.” This preferential option— a notion that was popularized by the liberation theology of Gustavo Gutiérrez—has inspired many physicians to seek out opportunities to provide holistic care to those on the margins of our communities, bringing medicine to people who are poor, underserved, and marginalized. For medical students like ourselves, taking up Farmer’s call to serve the poor is often centered around student-run free clinics.
These clinics, prevalent at nearly every medical school, are often boasted about on interview days and advertised as competitive volunteer opportunities. They are akin to a standard clinic in that they provide basic services like bloodwork or vaccinations free of charge, except it is almost completely operated by medical students, with varying degrees of oversight depending on the affiliate institution. Student-run free clinics play a small, but vital role in the safety net system through providing primary and preventative medicine to low-income, underinsured communities across the United States.
And yet, for many of these volunteers, the student-run free clinic might be the first time they ever complete a physical exam on a real patient, let alone talk to a real patient to collect a history. Most student volunteers at these clinics are in the early years of medical school—typically their first or second—when their time is primarily devoted to classroom instruction and rigorous exam preparation. Their clinical experience is often solely centered around standardized patients, where they are graded based on a checklist of items, including washing their hands and offering the patient a tissue to address their emotional needs. This medical student is seldom adequately prepared for their first patient encounter.
This paper thus seeks to explore this inherent tension between the social need to train medical students and the patient's need to receive care from a competent and experienced physician. Our health care system strives to be just but offers some patients care from world-renowned physicians, while others, especially those who are already most socially marginalized, spend most of their visits with first-year medical students who often do not speak their language, cannot fully assess them, or are unable provide them the healthcare guidance that they desire.
Farmer says, “Whether you are sitting in a clinic in rural Haiti, and thus a witness to stupid deaths from infection, or sitting in an emergency room in a U.S. city, and thus the provider of first resort for forty million uninsured, you must acknowledge that the commodification of medicine invariably punishes the vulnerable.” We wonder if “emergency room” can be replaced with “student-run free clinics”— with uninsured, impoverished, and suffering people sitting in the makeshift waiting rooms. Our clinics are never filled with patients with easy access to healthcare, regular check-ups, and robust insurance. We get to practice our skills in these clinics, but we wonder if it truly is justifiable to use the poor as practice subjects under the banner of providing healthcare. Farmer ends the sentiment with this: “A truly committed quest for high-quality care for the destitute sick starts from the perspective that health is a fundamental human right.” The often desperate people who come to safety-net clinics are met with students at the very beginning of their medical careers. We can be as kind, as thoughtful, and take as much time as we need with these patients, but we cannot replace a physician.
The beauty of these clinics is that medical students rush at the chance to be helpful, but the ugliness lies in the stark reality that we cannot be as helpful as the patients need us to be. The free clinics justify their existence by acting as a safety net in communities that may otherwise not receive care. And yet - we, the medical students who staff these clinics - see that they are often a bandaid trying to fix a hemorrhage. Perhaps the way we treat those at the margins of society calls for a more thoughtful solution, one rooted in the true option for the poor. And we wonder, uneasily, if relying on medical students to staff safety-net clinics truly satisfies the preferential option for the poor described by liberation theology.
These clinics, prevalent at nearly every medical school, are often boasted about on interview days and advertised as competitive volunteer opportunities. They are akin to a standard clinic in that they provide basic services like bloodwork or vaccinations free of charge, except it is almost completely operated by medical students, with varying degrees of oversight depending on the affiliate institution. Student-run free clinics play a small, but vital role in the safety net system through providing primary and preventative medicine to low-income, underinsured communities across the United States.
And yet, for many of these volunteers, the student-run free clinic might be the first time they ever complete a physical exam on a real patient, let alone talk to a real patient to collect a history. Most student volunteers at these clinics are in the early years of medical school—typically their first or second—when their time is primarily devoted to classroom instruction and rigorous exam preparation. Their clinical experience is often solely centered around standardized patients, where they are graded based on a checklist of items, including washing their hands and offering the patient a tissue to address their emotional needs. This medical student is seldom adequately prepared for their first patient encounter.
This paper thus seeks to explore this inherent tension between the social need to train medical students and the patient's need to receive care from a competent and experienced physician. Our health care system strives to be just but offers some patients care from world-renowned physicians, while others, especially those who are already most socially marginalized, spend most of their visits with first-year medical students who often do not speak their language, cannot fully assess them, or are unable provide them the healthcare guidance that they desire.
Farmer says, “Whether you are sitting in a clinic in rural Haiti, and thus a witness to stupid deaths from infection, or sitting in an emergency room in a U.S. city, and thus the provider of first resort for forty million uninsured, you must acknowledge that the commodification of medicine invariably punishes the vulnerable.” We wonder if “emergency room” can be replaced with “student-run free clinics”— with uninsured, impoverished, and suffering people sitting in the makeshift waiting rooms. Our clinics are never filled with patients with easy access to healthcare, regular check-ups, and robust insurance. We get to practice our skills in these clinics, but we wonder if it truly is justifiable to use the poor as practice subjects under the banner of providing healthcare. Farmer ends the sentiment with this: “A truly committed quest for high-quality care for the destitute sick starts from the perspective that health is a fundamental human right.” The often desperate people who come to safety-net clinics are met with students at the very beginning of their medical careers. We can be as kind, as thoughtful, and take as much time as we need with these patients, but we cannot replace a physician.
The beauty of these clinics is that medical students rush at the chance to be helpful, but the ugliness lies in the stark reality that we cannot be as helpful as the patients need us to be. The free clinics justify their existence by acting as a safety net in communities that may otherwise not receive care. And yet - we, the medical students who staff these clinics - see that they are often a bandaid trying to fix a hemorrhage. Perhaps the way we treat those at the margins of society calls for a more thoughtful solution, one rooted in the true option for the poor. And we wonder, uneasily, if relying on medical students to staff safety-net clinics truly satisfies the preferential option for the poor described by liberation theology.